WHEO Task ForceJoanna Cain, MD

Glenda Donoghue, MDSonya Erickson, MDDiane Magrane, MDJennifer Potter, MDTamara Stein, PhD

Roberta Rusch, MPH

APGO/WHEO Women’s Health Care Competencies for Medical Students

• Medical students must know how to care appropriately for female patients, regardless of specialty

• Sex & gender matter in health and illness

Women’s Health Care Competencies Project

Purpose:

Henrich, Acad Med 2004

Why Sex and Gender?

• Critically impact:

– Incidence (how common)– Etiology (cause)– Presentation (symptoms)– Progression (severity)– Likelihood of being

offered screening, testing, and treatment (access)

– Approach to testing (appropriateness)

– Response to treatment (outcome)

• HOWEVER… despite increasing recognition of the importance of sex and gender differences, undergraduate medical curricular reform has been slow

Undergraduate Medical EducationChallenges to Curricular Reform

Challenges Questions

Explosion in knowledge/skills What topics should be included?

How to organize/search efficiently?

Shift in teaching environment How to improve communication and collaboration between multiple sites/disciplines?

Assessment of competency How to ensure that evaluation tools are appropriate/accurate?

Emphasis on evidence base How to ensure accuracy/currency?

How can information be updated?

Women’s Health Care Competencies Project

Goals:

• To identify women’s health care competencies for medical students

• To develop a tool to evaluate, improve, and integrate these competencies into undergraduate medical education

Women’s Health Care Competencies Project

Methodology:

• November 2000 Interdisciplinary Retreat - Women’s Health Experts

• “Women’s Health Care Competencies for Medical Students” developed

Competency: basic knowledge, skills, and attitudes needed in order to provide appropriate preventive care and treatment to women

1. Explain sex and gender differences in normal development and pathophysiology

2. Effectively communicate demonstrating awareness of gender and cultural differences

3. Perform sex, gender, & age appropriate physical exam

4. Discuss impact of gender-based societal and cultural roles on health care

Women’s Health Care Competencies Project

8 Core Competencies:

Women’s Health Care Competencies Project

8 Core Competencies (cont.):

5. Identify and assist victims of physical, emotional and sexual violence & abuse

6. Assess and counsel women for sex- and gender-appropriate reduction of risk

7. Access and critically evaluate new information & adopt best practices of sex and gender differences in health and disease

8. Discus the impact of health care delivery systems on populations and individuals

Women’s Health Care Competencies ProjectWomen’s Health Care Competencies Project

Methodology (cont.)

• 2001 - Curricular tool/resource developed for two of the eight core competencies:

• APGO Undergraduate Medical Education Committee (UMEC)

• Professional Education Working Group of the National Centers of Excellence in Women’s Health (NCoE)

• WHEO Multidisciplinary Task Force

Women’s Health Care Competencies Project Explanation of the 5 column format:

1. Normal Physical & Psychological Differentiation & Development

Larsen, W.J. et al (eds), Human Embryology, 3rd ed. Churchill Livingstone, 2001. / Knobil E., Neill J.D. (eds.), Encyclopedia of Reproduction. San Diego, Academic Press, 1998, 4 vols. / Vander A.J., Sherman J.S., Luciano, D.S., Human Physiology, 8th ed. McGraw Hill, 2000.

Larsen, W.J. et al (eds), Human Embryology, 3rd ed. Churchill Livingstone, 2001. / Vander A.J., Sherman J.S., Luciano, D.S., Human Physiology, 8th ed. McGraw Hill, 2000.

Larsen, W.J. et al (eds), Human Embryology, 3rd ed. Churchill Livingstone, 2001. / Moore, K & Dalley, AF. Clinically Oriented Anatomy, 4th ed. Lippincott, Williams & Wilkins, 1999. / Netter, F & Hansen, JT. Atlas of Human Anatomy, 3rd ed. Novartis, 2003.

References

2b

2a, 2b

2b

ACGME Link

MCQ

Oral

KF

MCQ

Oral

KF

MCQ

Oral

KF

Eval Method

K

KH

KH

Level

Describe the role of androgens in the

differentiation of the urogenital tract

Compare the changes seen in the male and female urogenital tracts

from birth through senescence

Associate the male and female urogenital embryological structures with their adult counterparts

Learning Objective

Women’s Health Care Competencies Project Explanation of the 5 column format:

1. Normal Physical & Psychological Differentiation & Development

K

KH

KH

Level

Describe the role of androgens in the

differentiation of the urogenital tract

Compare the changes seen in the male and female urogenital tracts

from birth through senescence

Associate the male and female urogenital embryological structures with their adult counterparts

Learning Objective

Miller’s TriangleMiller’s Triangle

ProfessionalProfessionalauthenticityauthenticity

Miller GE. Academic Med 1990; 65:S63-67.Van der Vleuten, C. Ottawa Conference, 2000

Competency Based Education Why Do It?

Professional authenticity

Knows

Shows How

Does

Behavior

Cognition

Miller GE. Academic Med 1990; 65:S63-S67.Van der Vleuten, C. Ottawa Conference, 2000

Knows How

Competency Based Education Why Do It?

Professional authenticity

Knows

Shows How

Does

Behavior

Cognition

Miller GE. Academic Med 1990; 65:S63-S67.Van der Vleuten, C. Ottawa Conference, 2000

Knows How

Women’s Health Care Competencies Project Explanation of the 5 column format:

1. Normal Physical & Psychological Differentiation & Development

2b

2a, 2b

2b

ACGME Link

MCQ

Oral

KF

MCQ

Oral

KF

MCQ

Oral

KF

Eval Method

K

KH

KH

Level

Describe the role of androgens in the

differentiation of the urogenital tract

Compare the changes seen in the male and female urogenital tracts

from birth through senescence

Associate the male and female urogenital embryological structures with their adult counterparts

Learning Objective

Evaluation Methods:Evaluation Methods:ACGME Outcome ProjectACGME Outcome Project

www.acgme.org

ACGME Toolbox of Assessment MethodsACGME Toolbox of Assessment Methods

ACGME Competency SkillsACGME Competency Skills

• Six competency areas

• Skill sets defined

Women’s Health Care Competencies Project Explanation of the 5 column format:

1. Normal Physical & Psychological Differentiation & Development

Larsen, W.J. et al (eds), Human Embryology, 3rd ed. Churchill Livingstone, 2001. / Knobil E., Neill J.D. (eds.), Encyclopedia of Reproduction. San Diego, Academic Press, 1998, 4 vols. / Vander A.J., Sherman J.S., Luciano, D.S., Human Physiology, 8th ed. McGraw Hill, 2000.

Larsen, W.J. et al (eds), Human Embryology, 3rd ed. Churchill Livingstone, 2001. / Vander A.J., Sherman J.S., Luciano, D.S., Human Physiology, 8th ed. McGraw Hill, 2000.

Larsen, W.J. et al (eds), Human Embryology, 3rd ed. Churchill Livingstone, 2001. / Moore, K & Dalley, AF. Clinically Oriented Anatomy, 4th ed. Lippincott, Williams & Wilkins, 1999. / Netter, F & Hansen, JT. Atlas of Human Anatomy, 3rd ed. Novartis, 2003.

References

2b

2a, 2b

2b

ACGME Link

MCQ

Oral

KF

MCQ

Oral

KF

MCQ

Oral

KF

Eval Method

K

KH

KH

Level

Describe the role of androgens in the

differentiation of the urogenital tract

Compare the changes seen in the male and female urogenital tracts

from birth through senescence

Associate the male and female urogenital embryological structures with their adult counterparts

Learning Objective

Women’s Health Care Competencies Project

Methodology (cont.)::• 2003 - Interdisciplinary Group of Women’s Health Experts

gathered to develop curricular tool for each competency using UMEC/NCoE model

• 2003-04 - WHEO presented Competency project at NCoE conference, AMWA meeting, CREOG/APGO meeting, AAMC meeting, VCU School of Medicine Women’s Health Conference, IAMSE meeting

• 2004 - AMWA linked RHI Curriculum with APGO Competencies and we referenced RHI Curriculum modules throughout our resource

Women’s Health Care Competencies Methodology (cont.)::

• 2004- Web-based, interactive curricular tool: www.apgo.org/wheocomp

• 2005- Next step: RFA for Demonstration Projects (funded by the Ford Foundation). Available 4/05.

Look for information soon at: www.apgo.org

Curriculum Building Example: Women & Disabilities Conference

Step 1: Search databaseKeywords = ‘Disability’,

‘Disabled’

• Step 2: Select desired competencies

• Step 3: Organize and edit competency list

• Step 4: Edit learning objectives

Women & Disabilities Conference:List of Final Learning Objectives

1. Describe sex and gender differences in the prevalence and presentation of physical disabilities

2. Describe cultural issues related to disabilities, including attitudes of people from different cultures about women with disabilities, and the role of the family in caregiving

3. List quality of life indicators for women with disabilities 4. List barriers to care for women with physical disabilities, and

describe measures to increase health care access5. Outline age- and risk- appropriate preventive care recommendations

for disabled women across the lifespan, including screening for sexually transmitted illnesses and cervical cancer, contraceptive practice, mammograms, and bone density testing

6. Describe the prevalence of interpersonal violence among women with physical disabilities, and outline a management approach

Women & Disabilities Conference: Final Learning Objectives (cont.)

7. Describe the diagnosis and treatment of acute medical problems in women with disabilities, including autonomic dysreflexia

8. Describe the prevalence, presentation, and management of secondary complications that occur commonly in women with physical disabilities, including obesity, osteoporosis, pain, skin problems, sexual problems, bladder and bowel incontinence, depression, and fatigue

9. Describe the importance of developing participatory, ‘co-expert’ patient-clinician relationships with disabled women

10. Describe special equipment and modifications of the physical exam (including the pelvic exam) that facilitate comprehensive health assessment

11. Demonstrate how to perform a functional assessment of a disabled woman, and describe appropriate mobility aids